老年肾病综合征临床和病理分析

Clinical and Pathological Analyses in Nephrotic Syndrome of Elder

目的 :了解老年肾病综合征的临床表现和病理特点。方法 :对我院住院的 34例老年肾病综合征病人进行临床表现和病理类型分析。结果 :34例老年性肾病综合征 ,原发病为原发性肾小球肾炎者 2 3例 ,占 6 7.6 %,糖尿病肾病 6例 ,占 17.6 %。临床表现以浮肿、血尿为主 ,贫血的发生率为 35 .3%,慢性肾衰竭为 17.6 %。肾活检发现 ,原发性肾病综合征中膜性肾病最常见。老年肾病综合征病人用激素或激素加免疫抑制剂治疗的缓解率为 5 2 .9%,有效率为 2 6 .5 %,未缓解率为 2 0 .6 %。合并感染者占 14.7%。结论 :在肾病综合征中老年人所占比例并不高 ,其临床表现与年轻人的肾病综合征相似 ,但合并贫血、慢性肾衰竭 (CRF)和感染的比例较高 ,最常见的病因是慢性肾小球肾炎 ,其病理类型以膜性肾病 (MN)最常见。老年肾病综合征患者对激素或激素加免疫抑制剂治疗的反应尚可。

Objective: To understand the nephrotic syndrome in the elderly.Methods: Clicinal and pathological analyses were performed in 34 patients with nephrotic syndrome, whose age were over 60. Results: 34 cases of nephrotic syndrome were diagnosed in the elderly. Among them, 23 cases(67.6%) had chronic glomerulonephitis, 6 cases(17.6%) had diabetic nephropathy.The clinical features presented little difference from those of younger patients, although 35.3% of the patients manifested anemia, 17.6% displayed chronic renal insufficiency. Membranous nephropathy was the particularly common type in biopsy. Damsge to the intertitium in the kidey was often observed. Steroid and immunosuppressive agent were effective, with the relief rate of 52.9%, the effectiv rate of 26.5% and the uneffective rate 20.6%. Conclusions: The nephrotic syndrome in elderly patients was not common and the clinical features differ little from those of younger patients, although complicated anemia, chronic renal insufficiency were more common than those in the young. The ratio of infection were higher than that in their younger counterparts.Chronic glomerulonephritis was the most common cause of the nephrotic syndrome in the elderly, Membranous nephropathy was particularly common in pathological detection. Nephrotic syndrome in the elderly responded well to corticosteroids and immunosuppressive agents.